Active NPI
Martin Lee Waller II, LDO
- Optician
- Hixson, TN
National Provider Identifier
1982111936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- DPO0000002824
- Practice address
- 5301 Highway 153
Hixson, TN 37343-4966 - Phone
- (423) 877-9990
- NPI assigned
- Dec 29, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | DPO0000002824 | TN | Primary |
Addresses
Primary practice location
5301 Highway 153
Hixson, TN 37343-4966
Mailing address
5301 Highway 153
Hixson, TN 37343-4966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DPO0000002824 | TN | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514505600000",
"number": "1982111936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5301 HIGHWAY 153",
"city": "HIXSON",
"state": "TN",
"postal_code": "373434966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5301 HIGHWAY 153",
"city": "HIXSON",
"state": "TN",
"postal_code": "373434966",
"telephone_number": "423-877-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "MARTIN",
"middle_name": "LEE",
"name_suffix": "II",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-29",
"last_updated": "2017-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "TN",
"license": "DPO0000002824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hixson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.